Healthcare Provider Details

I. General information

NPI: 1629955489
Provider Name (Legal Business Name): HARMONY HEAVEN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11512 N PORT WASHINGTON RD STE 200
MEQUON WI
53092-3481
US

IV. Provider business mailing address

11512 N PORT WASHINGTON RD STE 200
MEQUON WI
53092-3481
US

V. Phone/Fax

Practice location:
  • Phone: 414-899-2365
  • Fax:
Mailing address:
  • Phone: 414-899-2365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TATYANA BABAKHANOV
Title or Position: PARTNER
Credential:
Phone: 414-899-2365